Organization
SMILE AMERICA PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TATYANA A LYSENKO DDS (DOCTOR OWNER)
(856) 722-0333
Entity
Organization
Contact information
Practice address
3201 RT 38, STE 102, MT LAUREL, NJ 08054
(856) 722-0333
(856) 722-9882
Mailing address
3201 RT 38, STE 102, MT LAUREL, NJ 08054
(856) 722-0333
(856) 722-9882
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
19107
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7047801
—
NJ
Enumeration date
02/06/2006
Last updated
03/14/2013
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